Historically born as the result of the de-institutionalization the case management has developed and undergone different phases till it has gained its place in the health care system of the establishment. In this essay goals, strength and limitations, different controversy and possible future of case management are discussed.
Case management process and contemporary issues
Case management: strengths and limitations today .Quality of care vs. cost saving.
Born as the result of the de-institutionalization the case management has developed and undergone different phases. It started in early 1970s represented by “system agents” (cited in Itagliata, 1982), who where non-clinicians, responsible for coordinating the patient care (Burns & Perkins, 2000). Later the “brokerage case management” was developed (cited in Holloway, 1991), that had rather limited role to develop certain services and link them with the patient. It soon came up that this service couldn’t cover the group of patients having complex needs (Burns & Perkins, 2000). Further more clinical skills and experience where required and little by little clinical staff replaced non-clinicians and took the leading role in the provision of care. Thus “full support” or it could be called “clinical case management” (cited in Holloway, 1991) took place. It went through the periods of innocence, controversy and consolidation till gained acknowledged place in the healthcare system (Burns & Perkins, 2000).
What are the main case management goals defined today? As described by Bower (1998, p.7) “overall goal of case management is to maintain individuals at their maximal level of comfort, functionality and independence, while at the most appropriate level of intensity of support”. Other authors outline two main tasks of the case management: (a) improving quality of patient’s life by finding appropriate services, and (b) reducing the impatient costs at the same time ensuring that more individuals could share the available resources (cited in Piette, Fleishman, Mor and Thompson, 1992). Case management programs if well developed and carried out according to the needs in some specific disease areas could bring significant effect. Research data suggest that appropriate case management program could reduce asthma morbidity, improve asthma management in children and students (Taras et al, 2004), and solve outstanding issues in HIV patients (Barney, Rosenthal, & Speier, 2004).
Appropriate case management program could create availability of the resources without duplicating the services (Barney, Rosenthal, & Speier, 2004).
Current tendency is not favourable for case management as quality ensure, because more often there is a risk shift from provider to payer. Unequal financial risk that is shared by physicians influences case management. Those having higher risk are more interested in the case management strategies. True accountability could be achieved when both financial and clinical risks are aligned (Bower, 1998).
Case management should evolve, meeting the needs of changing level of risk. While designing the case management programs the next level of risk should be taken into account. Bower (1998) suggested a two years perspective.
Future of the case management
Research data suggest that case management has its place and is an accepted member of health establishment. Burns & Perkins (2000) argue that future research in case management could focus on three areas: evaluation of estimated relative importance of the available components, evaluation of the types of present interventions, and evaluation of the interaction between the two.
The case management could outlast its obituaries if it will be considered and developed having as the main purpose to create relationship that could ensure the best evidence based treatment and rehabilitation for the patient (Burns & Perkins, 2000). Case management should show patient centred philosophy. It will allow adapting the strategy to the changing needs and maintain focus in combining on one hand modern, evidence based treatment, and on the other hand broader practical and social patient care (cited in Laugharne, 1999).
The “gate-keepers” of the case management.
Many different community developed elderly and mental healthcare programs where lacking access to the isolated high-risk patients (Elmet, 1991). With this regards, in 1978 R. Raschko developed the concept of “gatekeepers” (cited in Raschko & Coleman, 1989). Gatekeepers by definition are the people, who in their everyday activities came into contact with those, who may need assistance. Gatekeepers are serving like referral mechanism in the healthcare system (Elmet, 1991). In the research presented by Elmet (1991), findings suggest that lonely, high-risk patients were more often referred to health care facilities by gate-keeper service than by other, and the difference was by nearly 20%. This showed that gate-keeper service could be successfully used in the community health setting.
Case management programs have their place in the healthcare system. Quality of these programs depends on the strategy used case managers’ personality (Barney, Rosenthal, & Speier, 2004) and preparation, and the amount of risk shared (Bower, 1998).
Case management has the future if it will continue demonstrate patient-centred approach and primary focus on quality of patient care (Burns & Perkins, 2000).
“Gate-keepers” could be valuable mean of case management in elderly population, people with mental health, in situation, when these patients are not able to reach and profit of healthcare services themselves (Emlet, 1991).
Barney, D., D., Rosenthal, C., C., Speier, T. (2004). Components of successful HIV/AIDS case management in Alaska native. AIDS Education and Prevention, 16(3), 202- 217. Retrieved from ProQuest database.
Bower, K. (1998). Case management: Unraveling the confusion. Orthopaedic Nursing, supplement, 7-14. Retrieved from ProQuest database.
Burns, T., Perkins, R. (2000). The future of case management. International Review of Psychiatry, 12(3), 212- 218. Retrieved from ProQuest database.
Emlet, C., A. (1991). Integrating the community into geriatric case management: public health management. The Gerontologists, 31(4), 556-560.
Taras, H., Wright, S., Brennan, J., Campana, J., Lofgren, RM. (2004). The Journal of School Health, 74(6), 213- 219. Retrieved from ProQuest database.